Association between local anesthetic dosing, postoperative opioid requirement, and pain scores after lumpectomy and sentinel lymph node biopsy with multimodal analgesia Journal Article

   

Authors:	Pawloski, K. R.; Sevilimedu, V.; Twersky, R.; Tadros, A. B.; Kirstein, L. J.; Cody, H. S. 3rd; Morrow, M.; Moo, T. A.
Article Title:	Association between local anesthetic dosing, postoperative opioid requirement, and pain scores after lumpectomy and sentinel lymph node biopsy with multimodal analgesia
Abstract:	Background: Multimodal analgesia (MMA) during breast surgery reduces postoperative pain and opioid requirements, but the relative contribution of local anesthetic dosing as a component of MMA is not well defined among patients undergoing lumpectomy and sentinel lymph node biopsy (SLNB). Patients and Methods: We identified consecutive patients who underwent lumpectomy and SLNB with MMA from 1/2019 to 4/2020. Univariable and multivariable linear and logistic regression were used to examine associations between local anesthetics, opioid requirements in the post-anesthesia care unit (PACU), and pain scores in the PACU and on postoperative day (POD) 1. Results: In total, 1603 patients [median tumor size, 14 mm (interquartile range 8–20 mm)] were included. The median PACU opioid requirement was 0 morphine milligram equivalents (interquartile range 0–5). PACU maximum pain was none or mild in 58% of patients and moderate to severe in 42%; among 420 survey respondents, 56% reported no or mild pain and 44% reported moderate to severe pain on POD 1. On multivariable analysis that adjusted for routine components of MMA, increasing doses of 0.5% bupivacaine were associated with reduced PACU opioid requirements (β −0.04, 95% confidence interval −0.07 to −0.01, p = 0.011) and lower odds of moderate to severe pain (odds ratio 0.98, 95% confidence interval 0.97–0.99, p < 0.001). Local anesthetics were not associated with pain scores on POD 1. Conclusions: Higher amounts of local anesthetics reduce acute postoperative pain and opioid requirement after lumpectomy and SLNB. Maximizing dosing within weight-based limits is a low-risk, cost-effective pain control strategy that can be used in diverse practice settings. © 2021, Society of Surgical Oncology.
Keywords:	adult; controlled study; aged; major clinical study; sentinel lymph node biopsy; demography; tumor volume; opiate; body mass; narcotic analgesic agent; paracetamol; partial mastectomy; morphine; analgesics, opioid; lidocaine; anesthetics, local; bupivacaine; ketorolac; analgesia; postoperative pain; pain, postoperative; breast surgery; mastectomy, segmental; lumpectomy; local anesthetic agent; recovery room; control strategy; humans; human; male; female; article; anesthesiologist; pain severity
Journal Title:	Annals of Surgical Oncology
Volume:	29
Issue:	3
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2022-03-01
Start Page:	1737
End Page:	1745
Language:	English
DOI:	10.1245/s10434-021-10981-4
PUBMED:	34694521
PROVIDER:	scopus
PMCID:	PMC11110646
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85117860053&doi=10.1245%2fs10434-021-10981-4&partnerID=40&md5=d54063b7e33b86e610d4745475a9ed90
Notes:	Article -- Export Date: 1 March 2022 -- Source: Scopus

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